Provider Demographics
NPI:1245602762
Name:HACKETT CRUPI, BROOKE K (LCSW, RPT)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:K
Last Name:HACKETT CRUPI
Suffix:
Gender:F
Credentials:LCSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-7144
Mailing Address - Country:US
Mailing Address - Phone:207-944-8074
Mailing Address - Fax:207-990-3660
Practice Address - Street 1:261 US ROUTE 1 STE 302
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-3503
Practice Address - Country:US
Practice Address - Phone:207-944-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2025-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC15717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health